LTA Basketball Camp

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Athlete 1* This field is required.
First Name
Last Name
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Athlete 2
First Name
Last Name
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Best Contact Email* This field is required.
example@example.com
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Best Contact Phone (Call/Text* This field is required.
Please enter a valid phone number.
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Division* This field is required.
Please Select
Please Select
7th-8th
5th - 6th
3rd - 4th
K -2nd
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Parents Name* This field is required.
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Best Contact Phone?* This field is required.
Please enter a valid phone number.
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How did you hear about the basketball camp?* This field is required.
Social Media
Friend/Family
Flyer
Website
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Playing experience* This field is required.
AAU
Basketball Leagues (FBBA, New Territory)
Basketball Camps Only
None
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What skills are most important for your child to improve? (check all that apply)* This field is required.
Shooting
Ball Handling
Defense
Basketball IQ
Confidence
Conditioning
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Would you like more info about our weekly training and after school program? (Beginning September 6, the location will be 1464 Blaisdale Rd.* This field is required.
Yes
No
Maybe
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🔹 Acknowledgment of Risk* This field is required.
I, the undersigned parent/guardian, acknowledge that participation in basketball activities, practices, training sessions, games, and related events with Tx Supreme Fall Ball League (Lead Through Athletics) at 4 Quarters Gym involves risks, including but not limited to: falls, collisions, physical contact, sprains, broken bones, and other injuries. I understand these risks are inherent to the sport and cannot be eliminated.
I do not agree
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🔹 Waiver & Release* This field is required.
In consideration of my child’s participation, I hereby release, waive, and discharge Tx Supreme Fall Ball League, Lead Through Athletics, 4 Quarters Gym, coaches, staff, volunteers, and affiliates from any and all liability, claims, or demands for personal injury, property damage, or wrongful death arising from participation in league activities, whether caused by negligence or otherwise.
I do not agree
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🔹 Medical Treatment Authorization* This field is required.
I authorize Tx Supreme Fall Ball League and 4 Quarters Gym staff/volunteers to seek emergency medical treatment for my child in the event of injury or illness. I agree to be responsible for any associated costs.
I do not authorize
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🔹 Insurance Responsibility
I understand that Tx Supreme Fall Ball League and 4 Quarters Gym do not provide medical insurance for participants and that it is my responsibility to carry appropriate coverage for my child.
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Parent/Guardian Signature
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What do you value the most in youth sports program?* This field is required.
Fun
Skill Development
Competition
Teamwork
Mentorship
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Any additional comments or needs we should know about?* This field is required.
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Date Signed
Date
Month
Day
Year
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Are you or do you have any company interested in donating to Lead Through Athletics? (We are a 501c3 nonprofit organization.)* This field is required.
Yes
No
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ORDER SUMMARY
Total costUSD
Camp RegistrationMon - Thursday 9am -1pm
$130.00Edit
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Quantity
Single DayOne-day camp at 4 Quarters Gym for athletes ages 6–14. Includes skill training, scrimmages, and leadership lessons with Coach O and staff.
$50.00Edit
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Late Pick UpLate pickup is 3pm. Please have a lunch provided for your child.
$20.00Edit
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Total cost $0.00
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Payment Methods
Debit Or Credit Card
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